When launching an opioid safety initiative, you may encounter technology challenges, resistance from colleagues, or regulatory and legal constraints. It is important to identify these barriers as soon as possible and work with your team to resolve them. In this section we provide both an assessment tool to determine your organization’s readiness to implement an opioid safety initiative, and resources to help you think about potential regulatory and legal barriers to sharing potentially sensitive information.

How to Do It

Identify where process or technology/data issues will complicate implementation.

Understand how regulatory and legal issues may act as constraints.

Develop pragmatic strategies to address these obstacles.

Health Plan Stories

Blue Shield of California

At the start of the initiative, Blue Shield of California stakeholders were skeptical that anything could be done to address the opioid crisis.

At the start of the initiative, Blue Shield of California stakeholders were skeptical that anything could be done to address the opioid crisis. Medical standards of practice and physician training led to the aggressive treatment of pain, and opioid medications were commonly prescribed as a first choice. Blue Shield of California leadership met frequently with provider organizations and individual prescribers, sharing data and convincing stakeholders of both the problem and the strategy that would steer prescribing and opioid use to lower levels. Leadership asked providers to guide policy changes and then adapted interventions based on feedback. The increasing public awareness of the opioid epidemic and the publication of new national prescribing guidelines from the Centers for Disease Control and Prevention also helped to improve acceptance of Blue Shield of California’s Narcotic Safety Initiative.

The coalition hosts quarterly meetings to provide an opportunity for all workgroups to meet, celebrate successes, share information, and remove obstacles to goal achievement.

The coalition hosts quarterly meetings to provide an opportunity for all workgroups to meet, celebrate successes, share information, and remove obstacles to goal achievement. The “access to treatment” workgroup partners with 8–10 primary care providers and Federally Qualified Health Centers to integrate behavioral health and multidisciplinary medication-assisted treatment (MAT). The workgroup learned that Arrowhead Regional Medical Center, a county hospital system, had been awarded a grant to improve transitions of care. As a result, the workgroup expanded its scope to include bridging county emergency departments and primary care offices.

Maintaining a successful and meaningful coalition requires resources and leadership, which are both difficult to maintain. The coalition is constantly looking for new funding sources to support its work. The workgroups that have made the most progress include committed industry and community leaders who, in addition to their day jobs, invest their time and energy into the coalition and its efforts.

Kaiser Permanente Southern California

Some physicians were resistant to change.

Some physicians were resistant to change. Kaiser Permanente Southern California (KPSC) made a concerted effort to reeducate physicians on the impact of opioids and on appropriate prescribing practices. Today, all physicians are expected to prescribe appropriately; if outlier prescribers are identified, KPSC intervenes and provides individualized education and monitoring.

Physicians were worried that their patient satisfaction scores would drop if they refused to prescribe opioids. In response, KPSC adjusted its survey practices so physicians no longer had to worry that safer prescribing practices would impact patient satisfaction scores.

Partnership HealthPlan of California

Partnership HealthPlan of California recognized that its physician network could not change its prescribing habits overnight.

Partnership HealthPlan of California (PHC) recognized that its physician network could not change its prescribing habits overnight. PHC spent hundreds of hours in meetings with physicians, communicating why PHC was making changes in prescribing practices, what those changes were, and the impact it expected to achieve. PHC also heavily invested in provider training and in offering consultation support to providers for complex pain management patients. Finally, PHC rolled out changes slowly and incrementally, with substantial advance communication.

Tools

Stakeholder Readiness Assessment Tool

Understanding Legal and Regulatory Guardrails

Sharing potentially sensitive information is key to delivering and coordinating care that patients need. However, complex federal and state laws leave plans and providers unsure about what information can be safely shared.

Use these resources to learn more about how information may be safely shared to deliver services and coordinate care.